Adopted Children with Special Health Care Needs: Characteristics, Health, and Health Care by Adoption Type. Conclusion

10/08/2008

In the child welfare field, adoption has traditionally been viewed as an outcome, that is, the achievement of a goal for the child (Bay Area Social Services Consortium, 2005; Poertner, McDonald and Murray, 2000).  After finalization, the child is legally part of the adoptive family, which has assumed all rights and responsibilities of parents (Hollinger, 1993).  Limited follow-up may be conducted over the first few months, but rarely does extensive contact between the family and the agency, public or private, domestic or international, continue beyond finalization.  In recent years, however, the view of adoption as an outcome has gradually been replaced by a conceptualization of adoption as a process rather than a discrete event.  Adopted children and adoptive families face issues that continue and evolve over time, well beyond an initial adjustment period, and indeed throughout their lifetimes (Grotevant and Kohler, 1999). 

Many adoption agencies, both public and private, have begun developing post-adoption services, although their availability varies and it is unclear what proportion of families desire or make use of such services.  The development of post-adoption services for children adopted from foster care has been encouraged by the availability, since 2001, of funds for adoption promotion and support services through the federal Promoting Safe and Stable Families Program.  Funds received by states from the Adoption Incentives Program (created in 1997) may also be used for this purpose (U.S. House of Representatives, Committee on Ways and Means, 2004).  With respect to international adoptions, implementation in 2008 of the Hague Convention on Intercountry Adoptions has begun to improve the availability of post-adoption services for families.  This treaty affects adoptions between nations that have ratified it and went into effect in the U.S. in April 2008 (U.S. State Department, 2008).  Among its provisions is a requirement that all agencies conducting adoptions between nations participating in the treaty be accredited.  Standards for accreditation include items requiring the availability of post-adoption services3. While relatively few adoptions to the U.S. are subject to the Hague Convention at this time, many agencies performing international adoptions have sought accreditation because they operate in at least one country that has ratified the treaty.  Overall, the establishment of accreditation processes for intercountry adoption agencies has promoted the availability of post-adoption services for families adopting internationally. 

For CSHCN, continued or emerging special health care needs underscore that adoption is not a finite event, as families must adapt to meet the child’s ongoing needs.  These needs tend to be more extensive for CHSCN adopted from foster care than for other adopted CSHCN.  Data from the National Survey of Adoptive Parents will help illuminate the ongoing needs of adopted children and how their families utilize services available after the adoption is finalized.


3 The Council on Accreditation is the major body accrediting international adoption service providers.  Their accreditation standards regarding post-adoption services may be found at: http://www.coastandards.org/standards.php?navView=private&core_id=821

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